The induction of apoptosis has long been considered as a method of targeting cancer cells as well as pro-inflammatory, autoimmune cells, and other diseased cells. There are a number of cellular pathways involved in triggering cell death including the c-Jun N-terminal kinase JNK pathway. JNKs are responsive to cytokines and stress stimuli such as ultraviolet irradiation, heat shock and osmotic shock. Also activated in the response to cytokines and cellular stress is the NF-κB pathway. The NF-κB pathway can inhibit the JNK pathway by crosstalk mediated by Gadd45β and the JNK kinase, mitogen activated protein-kinase kinase 7 (MKK7/JNKK2). MKK7 activity is inhibited by Gadd45β, a member of the Gadd45 family of inducible factors and a direct transcriptional target of NF-κB. This means that Gadd45β mediates NF-κB suppression of JNK signalling by binding to MKK7 and inhibiting its activity. Papa, et al. 2004, Nature Cell Biology 6(2):1462153.
The use of NF-κB inhibitors has been proposed for use in the treatment of cancer and inflammatory diseases. However, because NF-κB has a number of activities including roles in PCD, immunity, inflammation and tissue development, it is preferred to inhibit specific functions of NF-κB rather than NF-κB itself.
The present invention relates to the inhibition of Gadd45β which is known to be up-regulated in a number of cancers and also in chronic inflammatory and hereditary disorders.
Multiple myeloma (MM), also known as plasma cell myeloma or Kahler's disease, is a cancer of plasma cells. Multiple myeloma is currently incurable, although temporary remissions can be induced by use of steroids, chemotherapy, thalidomide, proteasome inhibitors (PIs), e.g. bortezomib, melphalan, and stem cell transplants. According to the American Cancer Society, there are approximately 45,000 people in the United States living with multiple myeloma with approximately 15,000 new cases being diagnosed each year in the United States. The average survival time from diagnosis is approximately three years. Multiple myeloma is the second most prevalent blood cancer after non-Hodgkin's lymphoma and represents approximately 1% of all cancers and approximately 2% of all cancer deaths. The incidence of multiple myeloma appears to be increasing and there is also some evidence that the age of onset of the disease is falling. Thus, there is a clear need for improved treatments for multiple myeloma.
Nearly all multiple myeloma primary tumours and multiple myeloma cell lines display constitutive NF-κB activity. Blocking the activity of NF-κB causes multiple myeloma cell death. A major barrier to achieving long-term cancer treatment results with NF-κB targeting strategies is lack of specificity, and therefore poor treatment tolerability. This is due to the pleiotropic functions of NF-κB and of the proteasome. There is a need for a radically new therapeutic approach which is more specific, safer, and therefore more effective.
One of NF-κB's key functions in multiple myeloma is to promote survival. It has been shown (De Smaele, et al. (2001) Nature 414:306-313) that NF-κB affords cyto-protection by suppressing the INK MAPK cascade by means of Gadd45β, a member of the Gadd45 family of inducible factors. Gadd45β is up-regulated by NF-κB in response to various stimuli and promotes survival by directly targeting the JNK kinase MKK7 (Papa, et al. 2004 Nature Cell Biology 6:146-153, Papa, et al. 2007) J. Biol. Chem. 282:19029-19041, Papa, et al. (2008) J. Clin. Invest. 118:191-1923).
Proteasome inhibitors (PIs) and direct NF-κB inhibitors kill multiple myeloma cells by activating the JNK pathway, but are unsuitable for curative multiple myeloma therapy because of their indiscriminate effects on NF-κB and/or indiscriminate effects on the proteasome which prevents them being used at fully inhibitory curative doses.
In addition to multiple myeloma, Gadd45β is expressed at high levels in other tumours including diffuse large B-cell lymphoma, Burkitt's lymphoma, promonocytic leukaemia and other leukemias, as well as some solid tumours including hepatocellular carcinoma, bladder cancer, brain and central nervous system cancer, breast cancer, head and neck cancer, lung cancer, and prostate cancer. Therefore, inhibiting Gadd45β in these tumours may induce cancer cell death and so have beneficial therapeutic effects. Many haematological malignancies (including multiple myeloma, mantle cell lymphoma, MALT lymphoma, diffuse large B-cell lymphoma, Hodgkin's lymphoma, myelodysplastic syndrome, adult T-cell leukaemia (HTLV-1), chronic lymphocytic leukaemia, chronic myeloid leukaemia, acute myelogenic leukaemia, and acute lymphocytic leukaemia) and solid tumours (including breast cancer, cervical cancer, renal cancer, lung cancer, colon cancer, liver cancer, oesophageal cancer, gastric cancer, laryngeal cancer, thyroid cancer, parathyroid cancer, bladder cancer, ovarian cancer, prostate cancer, pancreatic cancer and many other cancers) are also known to exhibit constitutive NF-κB activation providing pro-survival signals to the cells at the expense of PCD which could otherwise lead to increased tumour cell death (V. Baud and M. Karin 2009, Nat. Rev. Drug Disc. 8: 33-40). Constitutive NF-κB activity is also found in melanoma, cylindroma, squamous cell carcinoma (skin, and head and neck), oral carcinoma, endometrial carcinoma, retinoblastoma, astrocytoma, and glioblastoma (V. Baud and M. Karin 2009, Nat. Rev. Drug Disc. 8: 33-40). Inhibiting Gadd45β in these tumours featuring aberrantly high constitutive NF-κB activity could also produce beneficial therapeutic effects by inducing programmed cell death in the cancerous cells. The present invention is based on the realisation that targeting the discreet pro-survival functions of NF-κB in cell survival via Gadd45β provides safer, more effective, therapy than does targeting NF-κB directly for a range of diseases and disorders including cancer and also other diseases characterised by aberrant cell survival or diseases which could be treated by the induction of increased PCD (such as autoimmune diseases, chronic inflammatory diseases, degenerative diseases and ischemic and vascular diseases).
A broad range of diseases and disorders depend on the activity of NF-κB. Indeed, the pathogenesis of virtually every known human disease or disorder is now being considered to depend on inflammation, and hence to involve NF-κB. This functions as a masterswitch of the inflammatory response, coordinating expression of an array of over 200 genes encoding cytokines, receptors, transcription factors, chemokines, pro-inflammatory enzymes, and other factors, including pro-survival factors, which initiate and sustain inflammation. The compounds of the invention inhibit the discrete pro-survival activity of NF-κB in inflammation. Therefore, diseases and disorders amenable to treatment with these compounds include, apart from conventional chronic inflammatory diseases (such as inflammatory bowel disease, rheumatoid arthritis, and psoriasis), other diseases and disorders that depend on a significant inflammatory component. Examples of such diseases and disorders, which are being treated with anti-inflammatory agents or NF-κB-inhibiting agents or have been proposed as suitable for treatment with NF-κB inhibitors and could also be treated with a compound of the invention, include:
1. respiratory tract: obstructive diseases of the airways including: asthma, including bronchial, allergic, intrinsic, extrinsic, exercise-induced, drug-induced (including aspirin and NSAID-induced) and dust-induced asthma, both intermittent and persistent and of all severities, and other causes of airway hyper-responsiveness; chronic obstructive pulmonary disease (COPD); bronchitis, including infectious and eosinophilic bronchitis; emphysema; bronchiectasis; cystic fibrosis; sarcoidosis; farmer's lung and related diseases; hypersensitivity pneumonitis; lung fibrosis, including cryptogenic fibrosing alveolitis, idiopathic interstitial pneumonias, fibrosis complicating anti-neoplastic therapy and chronic infection, including tuberculosis and aspergillosis and other fungal infections; complications of lung transplantation; vasculitic and thrombotic disorders of the lung vasculature, and pulmonary hypertension; antitussive activity including treatment of chronic cough associated with inflammatory and secretory conditions of the airways, and iatrogenic cough; acute and chronic rhinitis including rhinitis medicamentosa, and vasomotor rhinitis; perennial and seasonal allergic rhinitis including rhinitis nervosa (hay fever); nasal polyposis; acute viral infection including the common cold, and infection due to respiratory syncytial virus, influenza, coronavirus (including SARS) or adenovirus; or eosinophilic esophagitis;2. bone and joints: arthritides associated with or including osteoarthritis/osteoarthrosis, both primary and secondary to, for example, congenital hip dysplasia; cervical and lumbar spondylitis, and low back and neck pain; osteoporosis; rheumatoid arthritis and Still's disease; seronegative spondyloarthropathies including ankylosing spondylitis, psoriatic arthritis, reactive arthritis and undifferentiated spondarthropathy; septic arthritis and other infection-related arthopathies and bone disorders such as tuberculosis, including Potts' disease and Poncet's syndrome; acute and chronic crystal-induced synovitis including urate gout, calcium pyrophosphate deposition disease, and calcium apatite related tendon, bursal and synovial inflammation; Behcet's disease; primary and secondary Sjogren's syndrome; systemic sclerosis and limited scleroderma; systemic lupus erythematosus, mixed connective tissue disease, and undifferentiated connective tissue disease; inflammatory myopathies including dermatomyositits and polymyositis; polymalgia rheumatica; juvenile arthritis including idiopathic inflammatory arthritides of whatever joint distribution and associated syndromes, and rheumatic fever and its systemic complications; vasculitides including giant cell arteritis, Takayasu's arteritis, Churg-Strauss syndrome, polyarteritis nodosa, microscopic polyarteritis, and vasculitides associated with viral infection, hypersensitivity reactions, cryoglobulins, and paraproteins; low back pain; Familial Mediterranean fever, Muckle-Wells syndrome, and Familial Hibernian Fever, Kikuchi disease; drug-induced arthalgias, tendonititides, and myopathies;3. pain and connective tissue remodelling of musculoskeletal disorders due to injury [for example sports injury] or disease: arthitides (for example rheumatoid arthritis, osteoarthritis, gout or crystal arthropathy), other joint disease (such as intervertebral disc degeneration or temporomandibular joint degeneration), bone remodelling disease (such as osteoporosis, Paget's disease or osteonecrosis), polychondritits, scleroderma, mixed connective tissue disorder, spondyloarthropathies or periodontal disease (such as periodontitis);4. skin: psoriasis, atopic dermatitis, contact dermatitis or other eczematous dermatoses, and delayed-type hypersensitivity reactions; phyto- and photodermatitis; seborrhoeic dermatitis, dermatitis herpetiformis, lichen planus, lichen sclerosus et atrophica, pyoderma gangrenosum, skin sarcoid, discoid lupus erythematosus, pemphigus, pemphigoid, epidermolysis bullosa, urticaria, angioedema, vasculitides, toxic erythemas, cutaneous eosinophilias, alopecia greata, male-pattern baldness, Sweet's syndrome, Weber-Christian syndrome, erythema multiforme; cellulitis, both infective and non-infective; panniculitis; cutaneous lymphomas, non-melanoma skin cancer and other dysplastic lesions; drug-induced disorders including fixed drug eruptions;5. eyes: blepharitis; conjunctivitis, including perennial and vernal allergic conjunctivitis; iritis; anterior and posterior uveitis; choroiditis; autoimmune; degenerative or inflammatory disorders affecting the retina; ophthalmitis including sympathetic ophthalmitis; sarcoidosis; infections including viral, fungal, and bacterial;6. gastrointestinal tract: glossitis, gingivitis, periodontitis; oesophagitis, including reflux; eosinophilic gastro-enteritis, mastocytosis, Crohn's disease, colitis including ulcerative colitis, proctitis, pruritis ani; coeliac disease, irritable bowel syndrome, and food-related allergies which may have effects remote from the gut (for example migraine, rhinitis or eczema);7. abdominal: hepatitis, including autoimmune, alcoholic and viral; fibrosis and cirrhosis of the liver; cholecystitis; pancreatitis, both acute and chronic;8. genitourinary: nephritis including interstitial and glomerulonephritis; nephrotic syndrome; cystitis including acute and chronic (interstitial) cystitis and Hunner's ulcer; acute and chronic urethritis, prostatitis, epididymitis, oophoritis and salpingitis; vulvo-vaginitis; Peyronie's disease; erectile dysfunction (both male and female);9. allograft rejection: acute and chronic following, for example, transplantation of kidney, heart, liver, lung, bone marrow, skin or cornea or following blood transfusion; or chronic graft versus host disease;10. CNS: Atzheimer's disease and other dementing disorders including CJD and nvCJD; amyloidosis; multiple sclerosis and other demyelinating syndromes; cerebral atherosclerosis and vasculitis; temporal arteritis; myasthenia gravis; acute and chronic pain (acute, intermittent or persistent, whether of central or peripheral origin) including visceral pain, headache, migraine, trigeminal neuralgia, atypical facial pain, joint and bone pain, pain arising from cancer and tumor invasion, neuropathic pain syndromes including diabetic, post-herpetic, and HIV-associated neuropathies; neurosarcoidosis; central and peripheral nervous system complications of malignant, infectious or autoimmune processes;11. other auto-immune and allergic disorders including Hashimoto's thyroiditis, Graves' disease, Addison's disease, diabetes mellitus, idiopathic thrombocytopaenic purpura, eosinophilic fasciitis, hyper-IgE syndrome, antiphospholipid syndrome;12. other disorders with an inflammatory or immunological component; including acquired immune deficiency syndrome (AIDS), leprosy, Sezary syndrome, and paraneoplastic syndromes;13. cardiovascular: atherosclerosis, affecting the coronary and peripheral circulation; pericarditis; myocarditis, inflammatory and auto-immune cardiomyopathies including myocardial sarcoid; ischaemic reperfusion injuries; endocarditis, valvulitis, and aortitis including infective (for example syphilitic); vasculitides; disorders of the proximal and peripheral veins including phlebitis and thrombosis, including deep vein thrombosis and complications of varicose veins;14. gastrointestinal tract: Coeliac disease, proctitis, eosinopilic gastro-enteritis, mastocytosis, Crohn's disease, ulcerative colitis, microscopic colitis, indeterminant colitis, irritable bowel disorder, irritable bowel syndrome, non-inflammatory diarrhea, food-related allergies which have effects remote from the gut, e.g., migraine, rhinitis and eczema.
The present invention relates to novel inhibitors of the Gadd45β/MKK7 complex and/or signalling of that complex which may be used to inhibit the pro-survival function of NF-κB in cancer, inflammation, autoimmunity and degenerative, ischemic and vascular disorders.